CTG-Labor and delivery part2
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. When evaluated as an adjunct to CTG for intrapartum fetal monitoring ,of which outcome has ST analysis has been shown to reduce incidence? ?
A 32-year-old primigravida is in labour at term. She was started on an oxytocin infusion four hours previously because of slow progress. There is clear liquor draining. The CTG shows five contractions every 10 minutes, a baseline rate of 155 bpm, variability of 5-10 bpm, early decelerations in more than 50% of the contractions, and occasional accelerations for the last 90 minutes. Vaginal examination shows the head to be 1 cm above the ischial spines, in a right occipitoposterior position, and the cervix is dilated 7 cm. She has progressed 3 cm over the last four hours. Which of the following options would be most appropriate for her management?
A P1 in spontaneous labour at 39+1 weeks of gestation is being monitored by CTG because of raised blood pressure. She has a history of chronic immune thrombocytopenia. She is 4 cm dilated, draining clear liquor on admission and progressed to 8 cm in 4 hours. The CTG shows baseline of 145 bpm, variability 60 beats but late decellerations 50% contractions for the last 30 minutes. The woman has already had IV fluids and a change in position. You are called to review the CTG.
3) What is your first course of action
A 25-year-old G1P0 woman has had an uncomplicated pregnancy. She is currently at 39+1 weeks of gestation and reports a gush of clear fluid 5 hours ago. She is now contracting strongly, 4 in every 10 minutes. On examination the fetus is in a cephalic presentation with the head three-fifths palpable. Vaginal examination reveals an effaced cervix, which is 5 cm dilated. The head is at station –1 to the spines with no caput or moulding. The position is not defined and there is clear liquor draining. Which of the following is the most appropriate method for monitoring the fetus in this stage of labour?
A registrar is asked to review a prim igravida in labour who has progressed to 6 cm dilatation and has an abnormal CTG. The registrar reviews the case and confirms that the CTG has a baseline rate of 1 55bpm, a baseline variability of eight, no accelerations or decelerations. What ¡s the correct categorisation of this CTG?
A low-risk woman in her first pregnancy is in advanced labour. She is progressing well. One hour previously the cervix was dilated 7 cm and the head was at the spines. She has epidural analgesia for pain relief. The midwife is concerned about the CTG, and asks for your input. The CTG shows a baseline rate of 155 bpm and has recorded a sinusoidal pattern for the last 30 minutes. What is the most appropriate management option?
A woman is admitted for induction of labour at 42 weeks of gestation. After five hours she is contracting regularly 3 in 10 minutes with an oxytocin infusion of 2 mu/minute. The liquor is stained with thin meconium and the CTG shows atypical variable decelerations for the last 30 minutes; base rate 155b/m; variability 10-15 b/m. A vaginal examination reveals a vertex presentation and the cervix is 5 cm dilated. Which of the following is the most appropriate immediate course of action?
7)
A 32-year-old woman at 37 weeks in her first pregnancy is admitted for induction of labour as her baby has ultrasound-confirmed intrauterine growth restriction. In early labour, the CTG shows a baseline rate of 150 bpm, variability of 5 bpm, and infrequent variable decelerations, dropping from baseline by 60 bpm or less and taking 60 seconds to recover, recorded over the previous 45 minutes. She is contracting once every 10 minutes and the cervix is dilated 1 cm and 2 cm long. What is the most appropriate next step?
A primiparous woman at 33+4 weeks of gestation is admitted in labour at 11:30 and was found to be 3 cm dilated with the fetal head at –2 station. She ruptured membranes, draining clear liquor, at 13:20. You were called to review the CTG at 14:00: baseline of 150, variability 3, no accelerations and variable decelerations >60 beats and lasting >60 seconds for last 35 minutes occurring with almost every contraction. On vaginal examination she was 5 cm dilated and blood-stained liquor was noted.
9) What is the next most appropriate course of action?
Your year ST 1 junior colleague wants to know why electronic fetal monitoring (EFM) is the recommended method of intrapartum fetal surveillance for high-risk pregnancies.
10) What will you tell him?
When evaluated as an adjunct to CTG for intrapartum fetal monitoring, of which outcome has STAN (ST analysis) been shown to reduce incidence?
A 29-year-old para 2 with a booking BMI of 56 presents at 39+3 weeks gestation in labour. She is found to be 4 cm dilated and contracting 3:10 regularly. The presentation is uncertain, and the obstetric ST 3 is called to confirm fetal presentation. During the ultrasound the woman has a spontaneous rupture of membranes. Ultrasound suggests a footling breech presentation. On examination the woman is dysmorphic looking. Vaginal examination con rms 4 cm dilatation, but with a cord prolapse, and an emergency call is made. Th e ST 3 anaesthetist and S T7 paediatrician attend immediately, and the midwife telephones the consultant obstetrician and anaesthetist to come in from home. T e S 3 anaesthetist is concerned and alerts you to an antenatal assessment examination that includes Mallampati 3, thyromental distance 5 cm . T e C Ghasabaselinerateof140,variabilitygreaterthan5,noaccelerations and variable decelerations with fast recovery lasting less than a minute with every contraction. What would be the most appropriate immediate course of action?
29-yr old multiparous woman is admitted to labour ward at 6 cm dilatation at 32 week gestation. A CTG is commenced and demonstrates a baseline fetal heart reate of 140 bpm with deep variable decelerations to 60 bpm with slow recovery and normal variability. There is meconium staining of the liquor. The midwife has tried a change of maternal position for the past 90 mins with no improvement in the trace.
A woman in her first pregnancy, presents with decreased fetal movements for 24 hours. She is 34 weeks pregnant. A non-stress CTG shows the fetal heart rate is 180 bpm, variability is 3 bpm, and there have been unprovoked persistent deceler ations for the last 20 minutes. What is the most appropriate management option?
What proportion of intrapartum CTG with reduced fetal heart rate baseline variability and late decelerations results in moderate to severe cerebral palsy in children
The CTG shows a baseline rate of 150 beats per minute (bpm). Accelerations are absent and variability is 7 bpm. There are shallow decelerations occurring with contractions, and the fetal heart rate is falling by 20 bpm from the baseline and lasting 30 seconds, mirroring each contraction for 80 minutes. Contractions are four every 10 minutes. What is the overall classification?
The CTG shows a baseline rate of 150 bpm and accelerations are present. Baseline variability is 8 bpm, and there are decelerations, with the fetal heart rate dropping by 50 bpm and lasting 70 seconds. The decelerations start following each contraction for the last 25 minutes in a 40-minute trace. Contraction frequency is four every 10 minutes. What is the overall categorisation of the CTG?
A 27-year-old low risk primigravida at 38/40 weeks of gestation has rupture of membranes at 5 cm with thick meconium and uterine contractions at a rate of three in 10 minutes. She is commenced on continuous fetal heart monitoring and a plan is made for re-examination in 4 hours when she is found to be 6 cm dilated and has a normal CTG. Syntocinon is commenced following medical review. She is re-examined by the registrar 4 hours after onset of contractions at a rate of 4 in 10 minutes, and she is found to be 6 cm with 2+ caput. The CTG is non-reassuring.
18) What is the next most appropriate next step?
A 25-year-old woman, G1P0, has a BMI of 38. She is at 39+1 weeks of gestation and has had an uncomplicated pregnancy. She reports a gush of clear fluid 5 hours ago. She is now contracting strongly, 4 in every 10 minutes. On examination the fetus is in cephalic presentation with the head 3/5 palpable. Vaginal examination reveals an effaced cervix, which is 5cm dilated. The head is at station -1 to the spines with no caput or moulding. The position is not defined and there is clear liquor draining.
Which of the following is the most appropriate method for monitoring the fetus in this stage of labour?
A 28-year-old in her first pregnancy is induced at term plus 10 days. The CTG was normal before induction of labour; she was dilated 6 cm four hours previously and now is dilated 8 cm on vaginal examination. She has uterine contractions at a rate of two every 10 minutes. The CTG shows a baseline rate of 150 bpm, good variability and infrequent shallow variable deceleration. What is the next most appropriate action?
A 19-yr old primigravid woman is admitted to the labour ward in early labour at 41+4 weeks gestation. She is 1cm dilated and a CTG is commenced. This demonstrates a fetal baseline of 130 bpm, variability 5-15 bpm, acceleration and no deceleration
. A 36-year-old nulliparous woman in the second stage of labour has been pushing for 30 minutes. The CTG shows a fetal heart rate of 170 bpm, reduced variability and late decelerations having occurred for the last 25 minutes. Vaginal examination shows the head to be at the ischial spines in occipitoposterior position. Which of the following management options would be most appropriate?
A 29-year-old para 0 spontaneously labours at 38+3 weeks gestation and at 16:00 she is 5 cm dilated. At 18:00 decelerations are heard on intermittent auscultation and a C TG is commenced.Contractionsare 4:10, base rate is 150 bpm variability greater than 5 bpm, there are no accelerations and there are declarations with every contraction, mostly of greater than 60 bpm and for greater than 60 seconds. On examination at 18:30 the cervix is 9 cm dilated, and the fetus is direct occiput anterior at spines. A decision is made for fetal blood sampling. T hree good samples are taken at 18:40, and the results are lactates of 4.0, 3.9 and 3.8 mmol/L. What would be the most appropriate course of action?
A woman with a previous caesarean section is in labour at 39 weeks of gestation. She is 8 cm dilated. The cardiotocography (CTG) was initially classified as normal. You have now been asked to review the situation because the fetal heart rate has acutely dropped from 140 bpm to 70 bpm for 9 minutes, in spite of a left lateral position. What is the
24) most appropriate course of action?
The CTG shows a baseline rate of 140 bpm Accelerations are absent. Variability has been 3 bpm for 25 minutes. There are variable decelerations present, each lasting 70 seconds with every contraction for a duration of 40 minutes, with a delayed recovery and no shouldering. Contractions are three every 10 minutes. How should the decelerations in the CTG trace be described?
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